Shortly after my recent post, “How the Backlash to Oregon’s Plan to Taper Opioids with Integrative Approaches Missed the Mark”, I received an e-note from national pain leader Sean Mackey, MD, PhD. The letterhead of the chief of the division of pain medicine at Stanford University and co-chair of the US HHS National Pain Strategy was the vehicle through which Mackey and 100 co-signers successfully campaigned for the Oregon Health Authority to prevent forced tapering “of certain patient populations.” Mackey wrote that he presumed we had shared interests in bettering care, yet he thought there was a harmful “negativity” in my article: “May I suggest rather than a ‘missed opportunity’ message, you could easily frame it as ‘forced opioid tapering defeated – here is what we need to do next …'”
When Oregon announced in 2016 that it would shift its back and neck care for Medicaid clients from opioids toward acupuncture, spinal manipulation, massage, yoga therapy and mind-body methods, it was heralded as a breakthrough for pain treatment nationally. Inside that policy was a mandate many now consider even bigger news. Doctors were required to totally taper patients off opioids. A backlash propelled by a letter signed by over 100 conventional pain academics nationwide – plus with one notable signer from the integrative pain community – stopped Oregon’s planned expansion of the model in its tracks. While there are good reasons for caution on mandatory tapering, the one-sided reactivity missed a chance for practitioners and patients alike to gain more experience with non pharmacologic tools to rein in the known abuses associated with opioids.